Trends in long-term management of survivors of acute myocardial infarction by cardiologists in a government university-affiliated teaching hospital

Abstract

Background: Despite prospective randomized control trials showing that beta blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, and lipid-lowering agents improve survival rates after myocardial infarction (MI), these agents are routinely underutilized.

Hypothesis: Our aim was to determine the frequency with which cardiologists at a government, university-affiliated teaching hospital prescribe aspirin, beta blockers, ACE inhibitors, calcium-channel blocking agents (CCBs), and lipid-lowering agents in patients post MI. The patients were followed by their primary care physicians in this hospital after discharge. We evaluated changes in patients' medical management at an average of 24 months after discharge from the acute event.

Methods: Clinical data relative to long-term use of life-saving drugs in 156 survivors of definite MI (WHO criteria) at a government, university-affiliated teaching hospital were analyzed over a 24-month follow-up period.

Results: Over 90% of patients with acute MI were given aspirin and beta blockers at discharge. About 50% of these patients were given ACE inhibitors, only 25% were prescribed CCBs, and 21% were given lipid-lowering agents. At 24 months of follow-up, the percentage of patients receiving aspirin, beta blockers, and ACE inhibitors had fallen to 88% (p = 0.0408), 71% (p < 0.0001), and 43% (p = 0.1122), respectively, whereas use of lipid-lowering agents slightly increased (p = 0.4277). Use of CCBs had also fallen (p = 0.0001). Nonetheless, the use of aspirin, beta blockers, and ACE inhibitors was higher than that in the National Registry of similar patients at discharge (p < 0.0001).

Conclusions: Patients at a government, university-affiliated teaching hospital are likely to receive life-saving therapy at discharge, in accordance with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. There is a modest decrease in intake of these life-saving drugs during the follow-up period. As documented earlier, cardiologists in a teaching institution are more likely to prescribe established life-saving drugs than do primary care physicians. However, full-time primary care physicians at a university-affiliated teaching hospital continue to use these therapies at a higher rate than do those outside academic medicine.